The heart is a global organ. It works for the whole organism, so that a dysfunction is not only visible directly in the heart, but also in the lungs or the peripheral blood flow. Cardiovascular diseases affect the majority of the elderly population and belong to the most common causes of death. Moreover, cardiac diagnostics are also crucial previous to larger surgery, when it is to be determined if cardiac diseases are present. This article is supposed to introduce you to the cardinal symptoms of cardiac diseases, as well as necessary non-invasive examination techniques regarding this topic.

Welcome back! This is Part 4 of “Cardiology: An Introduction”. This is going to be a continuation of our examination of the various cardiovascular diagnostic approaches for patients with suspected heart disease. In the previous session, we talked about the basic beginning steps in making a diagnosis - the history, the physical exam, the electrocardiogram. Now, we are going to talk about more sophisticated tests, imaging tests in particular, that will help us diagnose heart disease and, in particular, the commonest heart disease - atherosclerotic heart disease, which can lead to heart attacks and sudden death. Here is a list of the non-invasive tests. What we mean by a ‘non-invasive’ test, is that we do not have to introduce anything inside the body. We also have invasive tests. And I will talk about that in just a moment. And you can see here that the basic tests are still included. For example, the electrocardiogram, the chest X-ray, and then we move on to more sophisticated imaging tests such as ultrasound test, the echo test. We move from there to X-ray, sophisticated tests such as the CAT scan, also called the CT scan which gives us very exquisite images of the heart. And finally, the magnetic-resonance imaging test, the MRI, which gives us very detailed pictures inside the heart. And, of course, we also can record the electrocardiogram over a long period of time - 24 hours, 48 hours, 72 hours in order to see if there are abnormalities in cardiac rhythm. Let’s start with the very basic test, that is the chest X-ray. And I will show you some examples a little later in this talk. But, basically, what the chest X-ray shows us… it shows us the heart, the ribs and the lungs and gives us a rough picture...

About the Lecture

The lecture Diagnostics II - Invasive and Non-Invasive Tests by Joseph Alpert, MD is from the course Introduction to the Cardiac System. It contains the following chapters:

Invasive and Non-Invasive Tests

Stress Tests

Nuclear and Non-Invasive Ischemia Tests

Rules for Ordering Tests

Included Quiz Questions

Which test should be ordered first for this patient?
A 55 year old male comes to the ER complaining of 2 hours of sub-sternal chest pain. He is sweating, pale, and has a blood pressure of 88/55 mmHg. His ECG shows the findings of an acute myocardial infarction. His heart sounds are soft and there are basilar crackles heard over both lung bases.

Coronary angiogram

Chest x-ray

Echocardiogram

CT angiogram

MRI

Which test should be ordered first for this patient?A 50 year old smoker complains of exertional chest discomfort when walking uphill on cold days. His father died of an MI at age 57. He has a BSA of 30 (obese).

An ECG, nuclear, or echo stress test

Chest x-ray

ECG

Echocardiogram

CT angiogram

The simplest and least expensive diagnostic test is which of the following: